Commentary: We Must Balance Gender Inequity in Medicine

A new initiative by women in health care and their allies actively aims to end workforce disparity.

The health care workforce is predominately female. And now, men are the minority in first-year medical school classes in the United States, according to the Association of American Medical Colleges. Yet, gender discrimination against women in medicine is pervasive. More than two decades of research shows disparities that affect pay, promotion, research funding, leadership opportunities, publishing success and more.

Julie K. Silver

Gender bias can lead to burnout and might cause women to avoid certain specialties, scale back their hours or leave the profession altogether. This can lead to workforce shortages, low retention rates, litigation and compromised patient care.

The Be Ethical Campaign, which I’m leading, is a strategic initiative by women in medicine and their allies that aims to correct workforce disparities by holding top leaders of institutions, medical societies, medical journals and funding bodies accountable. A white paper the campaign has produced, citing a large body of research, recommends leaders use a six-step process together with data-driven scientific methodology to drive desired change. Lists of metrics are included in the report so leaders can have easy access to “next steps.”

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Competence in workforce equity, diversity and inclusion is required of every health care leader. In medicine, being competent means using research to inform the work. The Be Ethical Campaign recommends data-driven solutions to gender disparities. The white paper proposes that leaders use a comprehensive set of metrics to identify where there are equity gaps. Data analysis should be done at least annually (longitudinal analysis), and progress, or any lack thereof, should be transparently reported to all stakeholders.

The Be Ethical Campaign proposes leaders take an honest look at their histories and see if they can say yes to all these statements:

• I am knowledgeable about the research on workforce gender equity and can cite specific studies and statistics.

• I avoid committing errors in critical thinking and blaming women in medicine for the disparities they face.

• An audit of what I control in my organization would likely demonstrate that women are represented equitably, and they are paid and promoted equitably at every level.

• I have used my influence and resources to address workforce gender equity issues and can demonstrate my successes through a systematic, data-driven and transparent approach to promoting equity.

• I am regularly collecting the data I need, and I have developed and will continue to develop goals, policies and procedures to successfully address any existing or developing disparities.

If they cannot, they owe it to their trainees, colleagues and patients to use their considerable intellectual and financial capital to bring about change.

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That requires that they become knowledgeable about the research on workforce gender equity and avoid making critical thinking errors, such as blaming women for the discrimination they face. Every leader’s legacy depends on whether he or she takes action now. This is an urgent ethical imperative.

Julie K. Silver, MD, is an associate professor and associate chair for the Department of Physical Medicine and Rehabilitation at Harvard Medical School and focuses on strategic initiatives for the Spaulding Rehabilitation Hospital Network. She is the director of a Harvard Medical School CME course, Career Advancement and Leadership Skills for Women in Healthcare.